Definition
- Pancreatic cancer refers to malignant tumours originating from the pancreas.
Etiology
- Main types: Adenocarcinoma (arising from exocrine cells, most common) and neuroendocrine tumours (less common).
- Risk factors:
- Chronic pancreatitis.
- Smoking.
- Obesity.
- Family history of pancreatic cancer or certain genetic mutations (e.g., BRCA2, PALB2).
- Diabetes.
- Age > 60.
Clinical Presentation
- Often asymptomatic until advanced stages.
- Jaundice (particularly with tumours in the head of the pancreas).
- Unexplained weight loss.
- Abdominal pain radiating to the back.
- Nausea and vomiting.
- Pale stools and dark urine (due to obstructive jaundice).
- Recent onset diabetes.
Investigations
- Abdominal CT scan: mainstay for diagnosis and staging.
- Endoscopic ultrasound (EUS) with fine-needle aspiration: for tissue diagnosis.
- MRCP: to evaluate bile and pancreatic ducts.
- CA19-9: tumour marker, though non-specific, can be elevated in pancreatic cancer.
Management
- Surgical resection (Whipple procedure or distal pancreatectomy): the only curative option but applicable to a minority of cases.
- Chemotherapy (e.g., gemcitabine, FOLFIRINOX).
- Radiation therapy: in certain situations, often combined with chemotherapy.
- Palliative care: for symptom management in advanced disease.
- Stenting for bile duct obstruction.
- Pain management.
Prognosis
- Generally poor with a low 5-year survival rate due to late diagnosis in most cases.
- Early detection and resection offer the best chance of long-term survival.
Complications
- Metastasis, commonly to the liver.
- Biliary obstruction leading to jaundice.
- Thromboembolic events (e.g., deep vein thrombosis).
- Ascites.
Prompt diagnosis and management are critical for patients with pancreatic cancer, as the prognosis is generally poor. A multi-disciplinary approach involving gastroenterologists, oncologists, and surgeons is essential for optimal care.
